Q.3- Autopsy series, IVUS and carotid ultrasound studies, as well as coronary calcium studies have all shown that about 50% of middle age populations have significant atherosclerosis. This highly prevalent condition is reminiscent of tooth decay which affects half of adults and resulted in water fluoridation policy. Do you think such an approach is warranted for low dose statin?  If not nationwide, how about for counties with ASCVD rates above national average? Over a decade ago polypill was viewed as a potential panacea, is there any hope for polypill in primary prevention or the hope is dead? Hypothetically, if PCSK9 inhibitors were completely free would you have recommended a monthly or semi-annual injection to all over 40 or 50?

Shall we take a contrarian view and consider atherosclerosis a benign disease that needs no therapy but we should focus on the dangerous, malignant, or “vulnerable” types of atherosclerosis? If so do you think that risk factors of vulnerable plaques might be different from risk factors of atherosclerosis? Does pursuing vulnerable plaque still make sense or we should move on to the “vulnerable patient”, and treat an individual with atherosclerosis in any vascular bed as high risk regardless of focal pathology?